CO-WORKER QUESTIONNAIRE

Name and Rank*

First NameLast Name

Your rank or title*

Email*

example@example.com

Phone Number*

Area CodePhone Number

1. Applicant's name

2. What is the name of the agency/company you work(ed) at together?*

3. How long did you work together?*

4. How would you describe your relationship with the applicant?*

5. What terms would you use to describe the applicant to someone else?*

6. How would you describe the applicant's communication skills?

7. Have you seen the applicant in a stressful situation, if so, how did they handle it?*

8. Do you feel the applicant can adapt and handle new material?*

9. How does the applicant treat people in general?*

10. Have you seen the applicant express any bias or prejudice?*

11. How would you describe the applicant's judgement and decision making process?*

12. Do you feel the applicant is a person with integrity and honesty?*

13. Has the applicant ever been impulsive or acted in a reckless manner while driving?*

14. Can the applicant function in a team environment?*

15. Can the applicant work with people of different ethnicity and or genders?*

16. Have you ever seen the applicant lose control of their emotions?*

17. Do you believe the applicant is dependable?*

18. Can the applicant be assertive and confront a problem when necessary?*

19. Are you aware of any substance abuse issues with the applicant? (Please do not reveal any medical information)*

20. Is the applicant a confident person? How does the applicant handle criticism?*

21. Have you ever observed or heard of the applicant doing or saying, posting or texting anything inappropriate?*

22. What is this applicant's strongest character feature?

23. What is this applicant's weakest character feature?*

24. As a co worker, what kind of employee was the applicant, in relation to commitment, reliability, and loyalty?*

25. Can you think of any reason why the applicant should not be offered this job?*

26. Can you think of any reason why the applicant could not perform this job?*

27. Would you recommend the applicant to work in a position of public trust?*

28. The State of California requires background investigators to develop secondary references. These are people you may know of that know the applicant and can provide additional information. These individuals are not listed in the applicant's PHQ. Help us by providing a name, phone, and email address and their association with the applicant. Thanks

Name and email please

Name of the Investigator who provided this questionnaire?*

Please verify that you are human*